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Re: The op-ed article "MANY DOCTORS LACK TRAINING TO EASE PATIENTS' SEVERE PAIN (USA Today 9/8/03)
Dr. Diane Meier is correct in her assessment of the extent of suffering in hospitals, but her solution to the problem is misconceived. Essentially, she proposes fixing poor care by establishing a new payment system called palliative care, which would ensure that hospitals and doctors get paid for relieving pain.
Palliation derives from the Latin word "pallium," which means "cloak." In current usage, palliation has become simply a synonym for good care. If Dr. Meier proposes paying hospitals for good care, does that mean that if there is not separate reimbursement, we can look forward to continued poor care? It makes far more sense to view quality medical care as an entitlement.
More disturbing however, is that every single solution Dr. Meier proposes in her piece is already available, has been accessed by over 800,000 people this year, and millions of people over the past 20 years. This system is called hospice, and Congress has recognized its value by making it available as a Medicare and Medicaid benefit to all Americans. The theory and application of pain control and the psychological and spiritual relief of symptoms have been available in hospice for decades. Rather than seek complicated new schemes that tap public moneys, hospitals should bring palliative care concepts into their systems by inviting hospice physicians and clinicians to share their knowledge, which applies to the chronically ill as well as the terminally ill. In that way hospitals can provide quality comfort care to the chronically ill (which they should have been doing all along), and let the terminally ill spend their last days at home, where survey after survey shows they wish to be, rather than in an institutional setting.
David Abrams
President
Hospice Foundation of America
2001 S. St. NW #300
Washington, DC 20009
305-981-3316 (Day)
954-920-4178 (Eves)
305-981-3390 (Fax
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